Sex, Society, and HIV: Creating a Sexually Healthy Society

Editor’s Note: This article is part of a series developed by the American Social Health Association (ASHA) in celebration of Sexual Health Month (September) 2012.See all the articles published by RHRC here and visit ASHA online. Cross-posted with permission from the American Social Health Association (ASHA).

In late July, the XIX International AIDS conference was held in Washington, D.C. It had been 22 years since the conference was last held in the United States, largely due to the unwillingness of the United States to grant visas for HIV-infected individuals; a ban that was only recently—and only partially—lifted as it left sex workers and intravenous drug users out.

The conference is history but not its lessons. Medical advances, improved access to care, prevention initiatives, and revived determination were all part of the progress noted by presenters, but as a global culture we need to shift our perspective to stop the spread of HIV.

Recent news of pre-exposure and post-exposure prophylaxis treatment has also been encouraging. This summer, the Food and Drug Administration (FDA) approved the drug Truvada for Pre-Exposure Prophylaxis (PrEP) to prevent the spread of HIV to high-risk, healthy individuals. Similar preparations are under investigation, and HIV therapeutic drugs are being developed for prophylactic use. These drugs are very costly and require individuals to adhere to rigid compliance in order to be effective.

Secretary of State Hillary Clinton gave the plenary address at the AIDS conference, calling for realization of President Obama’s determination to create an AIDS-free generation. With advances in treatment and prevention, she declared that we could see this within our lifetimes. But will we really see an end to AIDS?

While we see great progress in halting mother-to-child transmission, we have not seen this in other populations. New infections have ebbed slightly, but we still see an alarming rise in infection in groups with increased vulnerability due to poverty, stigma, and discrimination. People of Color, youth, and sexual minorities are much more likely to become infected than are other groups.

Infections among gay and bisexual men, other men who have sex with men, and transgender people continue to climb globally. While 60 percent of new infections in the United States are found in gay and bisexual men, only a fraction of the national prevention budget is directed at this group. Also, transgender individuals are an overlooked population, at major risk for HIV, due in large part to continued stigma and discrimination. This disparity in funding represents the institutionalized stigmatization, heterosexism, and homophobia that exist in our culture as well as in our public health systems. If we do not attend to this population, as well as other marginalized populations such as sex workers and drug users, we will fail in our effort to stop the spread of infections.

We know that HIV is still mostly spread by sexual behavior. Yet, the disease is rather easily preventable through the use of condoms. Condoms are reasonably inexpensive, potentially readily available, easy to use, and highly effective in preventing HIV and other sexually transmitted infections (and unintended pregnancy). What a bargain! So, why are they not used more?

Behavioral HIV-prevention strategies and interventions have tried to get people to reduce risky sexual behavior and promote condom use. While reasonably effective, there needs to be continuous implementation of these interventions, and they are costly.

A fundamental problem remains. We are a sexually dysfunctional culture. We live in a culture that is still uncomfortable talking about sex and sexuality in a mature and honest fashion. We continue to hold back on providing comprehensive sexuality education. It is very clear that what distinguishes sexually healthy cultures from those that are not is early and sustained comprehensive sexuality education. When kids are educated early, they grow up to be more comfortable talking about sexuality, more likely to be sexually responsible, and have lower rates of sexually-transmitted infections and unintended pregnancies. They contribute to a cultural climate that is sexually healthy. In most parts of the world, we are still caught up in a negative and unhealthy vicious cycle.

We need a broad sexual-health approach to stem the tide of the HIV epidemic. It should emphasize a positive and respectful approach to sexuality and sexual expression throughout the lifespan, acknowledge sexuality as a basic and fundamental aspect of our humanness, and view the pursuit of sexual pleasure as natural and desirable. A broad sexual health approach combats sexual coercion, shame, discrimination, and violence.

On an individual level, the approach must promote positive sexual identity, honest communication, the promise of satisfying sexual experiences, and the need to take responsibility for the consequences of one’s sexual choices. The community can achieve a broad approach to sexual health through access to comprehensive sexuality education, clinical and preventive sexual-health services, respect for diversity, and a lack of societal prejudice, stigma, and discrimination.